Organizational Culture and Quality of Life in Nursing Homes: A Qualitative Study

描述(由申请人提供)：本论文研究了组织文化对两家养老院生活质量的影响。之前对养老院的人种学研究表明，旨在提高护理质量的官僚法规导致了对组织效率的强调，这与关怀的伦理相冲突。本文通过分析围绕官僚主义监管的不同组织文化如何影响照顾者根据居民个人需求定制护理的能力，重新审视了这一观点。我在两家备受好评的疗养院进行了民族志研究，这两家疗养院在结构特征上相似，但在组织文化上不同，特别是在处理官僚程序的方法上。因此，本研究的问题是：不同的组织文化如何塑造养老院关怀环境的形成？之前对养老院生活质量的评估使用了简短的观察作为数据来源， 同时还进行了病人调查。拟议项目的比较民族志设计深化了 通过提供对组织流程的详细、长期的描述来分析生活质量 在生活质量调查中产生不同的结果。人种学让我能够研究照顾 随着时间的推移，关系会随着周围环境的变化而变化。在这种方法之外，我 制定分析类别，以评估照顾者对居民情感需求的关注程度。这项研究的长期目标是开发工具来分析不同 关于养老院和其他长期护理机构生活质量的组织结构和文化。正如保健研究和质量机构的目标所强调的那样，组织效率是提高疗养院等保健设施的整体护理质量的必要目标。这项研究旨在提高我们对卫生保健组织如何保持一定水平的效率，同时促进回应患者的社会、情感和精神需求的实践的理解。因此，本文提出了AHRQ在制定医疗质量措施、提高医疗服务效率以及促进以患者为中心的医疗方法方面的兴趣。

DESCRIPTION (provided by the applicant): This dissertation examines the effects of organizational culture on quality of life in two nursing homes. Previous ethnographic studies of nursing homes suggest that the bureaucratic regulations meant to improve quality of care lead to an emphasis on organizational efficiency that conflicts with an ethic of caring. This dissertation re-examines this idea by analyzing how different organizational cultures surrounding bureaucratic regulation affect caregivers' abilities to customize care to residents' individual needs. I conduct ethnographic research in two well-regarded nursing homes that are similar in structural characteristics, but vary in organizational culture, particularly in their approaches to bureaucratic procedure. Therefore, this study asks: How do different organizational cultures shape the formation of a caring environment in nursing homes? Previous assessments of quality of life in nursing homes have used brief observation as a source of data, alongside patient surveys. The comparative ethnographic design of the proposed project deepens the analysis of quality of life by providing a detailed, long-term account of the organizational processes that produce different outcomes in quality of life surveys. Ethnography allows me to examine how caregiving relationships change over time in response to their surrounding circumstances. Out of this approach I develop analytic categories for assessing the degree to which caregivers attend to the emotional needs of residents. The long-term goal of this study is to develop tools for analyzing the effects of different organizational structures and cultures on quality of life in nursing homes and other long-term care facilities. As emphasized in the goals of the Agency for Healthcare Research and Quality, organizational efficiency is a necessary aim for improving overall quality of care in health care facilities such as nursing homes. This study seeks to improve our understanding of how health care organizations can maintain a certain level of efficiency, while promoting practices that respond to patients' social, emotional, and spiritual needs. Therefore, this dissertation advances AHRQ's interests in developing measures of health care quality, improving efficiency in health services, and promoting a patient-centered approach to care.